Wednesday, January 31, 2007

Today I went to class, dropped by the Basic Science Journal Club for some stimulating science, and visited the Mt. Zion UCSF cancer center for the first time. When I got home and opened up my e-mail this afternoon, I learned that a former patient whom I met at Stanford last year recently died from pancreatic cancer.

So far, I have postponed discussing my secret obsession with oncology, but this news has prompted me to start reflecting again. Certain stages of pancreatic cancer have a median life expectancy of six months, and when I heard that a former patient had passed away, it flashed me back to the old feeling that another soldier has fallen.

And then I always start thinking about my former interactions with that patient...When did I first meet him? What did we talk about? What did he look like? Every death is like a small electrical shock to me, and it forces me to think about the mysterious void that we all seem to disappear into eventually. To flesh out this concept, I am attaching a piece of an essay that I wrote last year for medical school:

"Growing up, I felt haunted by the loss of a grandfather whom I would never meet. Tiptoeing around this void as a child was like trying to resist the gravitational force of a black hole. Since my grandfather died from colon cancer when my mother was seventeen years old, I never had the opportunity to meet this shadowy figure buried somewhere in a New York City cemetery. A passage from Tom Stoppard’s Rosencrantz and Guildenstern perfectly expresses that curious emptiness left by my grandfather: “Death is not anything...death is not...It's the absence of presence, nothing more...the endless time of never coming back...a gap you can’t see, and when the wind blows through it, it makes no sound.”

For the past seven months, I have worked at Stanford University Medical Center as the full-time clinical research coordinator, and the most compelling part of my job stems from my close interaction with terminally ill patients.

Of all these patients, I will never forget Mr. David Lee,* a seventy-five-old patient with metastatic gastric carcinoma whom I met during my first week. He was a cheerful, little old man with round glasses and a padded suit jacket that hid how emaciated he had become underneath. When Mr. Lee visited us last July, he was already dying. As he sat in the examination room with his wife and three grown children, the hardest thing that I have yet experienced was being present when Mr. Lee learned that he would likely die within six months.

After the doctor gently suggested that the family should consider “end of life” options, Mr. Lee’s daughter broke into uncontrollable sobs. I struggled to maintain eye contact with David Lee and his family in the cramped clinic room. It was difficult to breathe and remain objective in the midst of such grief. For the rest of the week, I could feel the blood pounding in my brain as my head ached with unshed tears. The greatest challenge in working with patients who have gastrointestinal cancers is learning to accept that some people will never quite recover from their illnesses and that no families will ever be the same. Two months later, Mr. Lee passed away.

Strangely, I cannot forget Mr. Lee. I remember his shuffling gait, his facial expressions, and his plastic frame glasses with remarkable clarity. What I marvel about death is its ability to take away someone so real and lifelike to me…to make him disappear into a void. That is the mystery of death that Guildenstern so eloquently described: how can Mr. Lee exist and yet not exist anymore? The more I pondered this, the more I realized that Mr. Lee represents to some degree an echo of my missing grandfather.

Working with terminally ill patients every day teaches me that I can be stronger, wiser, and more compassionate. But the deaths of patients like Mr. Lee also push me to realize that I am imperfect, that any clinical study is imperfect, and that our knowledge of cancer remains imperfect. Learning to recognize these imperfections and yet refusing to simply accept them motivates me to continue my research when I am a medical student and a physician to develop new treatment therapies against cancer in a never-ending quest to enhance a patient’s quality of life and chances for survival.

My reasons for pursuing a career in medicine stem from the people who have impressed me deeply, such as cancer patients like Mr. Lee. And yet, ironically, if I were to trace back the origin of my interest in healing and helping others, it would lead back to the void left by another person suffering from cancer whom I will never meet."

Tuesday, January 30, 2007

Unlike serious, stuffy organs like the heart, brain, and lungs...the kidneys, I have realized, are bodily organs with a sense of humor. It should have been obvious from the beginning because on gross pathology, the kidneys are cute, bean-shaped organs hiding underneath the fatty tissue slightly above the small of your back. Hence the term "kidney punch," the phrasing of which tickles my funny bone (it's so 'humerus') for some strange reason. One lecturer likes to say that some diseases involve "a good kidney in a bad world."

My penchant for anthropomorphism extends to all organs...the heart is a no-nonsense workhorse, while the lungs are spongy and passive. The kidneys never take themselves seriously and strangely remind me of myself: small, quirky, and complicated.

Maybe if I actually started studying the material regularly, this block will be more productive. I'm starting to realize that maybe passively absorbing information for three weeks and then cramming for the last 2.5 days before the exam is like eating a candy bar for breakfast...sure, it's a quick fix that can get me through the day...but it's not very soul-satisfying and the effects fade quickly.

Sorry for the dearth of entries lately, lots of things have happened in the meantime...such as a medical school formal or "prom" at the Hyatt Hotel at Fisherman's Wharf last Saturday and a fascinating case spanning several problem-based learning (PBL) sessions involving a fictional young man coughing up blood. Today, Dr. Stan Glantz gave a really interesting talk about the links between tobacco, restaurant economics, and heart attacks. This paragraph has no relation to the rest of the entry and the sentences have no relation to each other. Back to the kidneys.

There are A LOT of pathology/histology slides this block involving the kidneys. The lecturer who teaches us these slides likes to insert normal pictures of flowers, fruitstands, buildings, art work, and encourage us to interpret them as "glomeruli," "crescents," "humps," "necrosis," and "mesangial cells." At first, it was sort of interesting and novel...but now I feel like it's a little obsessive. She is extremely nice, however, and I appreciate her efforts to make histology more stimulating. Apparently, I have to the opposite problem: I like to look at histology slides and interpret the cells, staining, and shapes as everyday objects. Each slide is a Rorschach ink blot to me...sometimes I see a big slug, a happy face, two Picasso creatures mating, or a cylinder of red Cheerios. It was also nice of the lecturer to assert that pathology slides are like works of art...every interpretation is in the eye of the beholder. To synthesize these thoughts into a coherent ending, I'm going to post a picture that draws together art, interpretation, and the kidneys...it's a gorgeous sculpture in Chicago called "The Cloud Gate" that locals have dubbed "the Bean." Until recently, the only silver "bean" in my repertoire of free association involved expensive jewelry from Tiffany's, but now I look at this picture and see a big shiny glorious KIDNEY.

Wednesday, January 24, 2007

Once again, my blog has fallen silent because of an exam...it seems to be the only thing that can keep me away from updating compulsively! However, the exam has come and gone, and we are done with the lungs. Bye bye lungs. Welcome kidneys! The kidneys are rumored to be one of the hardest blocks in our first year at UCSF, so I should study more this month. We saw some beautiful slides today of the glomerulus (it took me ten minutes to figure out how to say it like a pro..."gloh-mare-ru-lus" as opposed to "gloh-mer-roo-lus"). Since I can't see anything in slides anyway (histology is not my bag, baby), I like to amuse myself by hallucinating and imagining what the image reminds me of. Aesthetically, some of these images are fantastic and I wouldn't mind hanging a few on my wall someday. The slides above remind me of stained glass windows; it's like I'm in a church! Yes, the kidneys are quite a religious experience.

Thursday, January 18, 2007

UCSF sits atop a hill in San Francisco, which gives everyone a beautiful view of the city. Last year, someone mentioned that one of the things that they love is "beautiful views," which I thought was intriguing because I had never considered "views" as a commodity or interest, but rather something incidental or spontaneous.

Colorful, gaudy houses are a signature feature of San Francisco. Funky pastel is an architectural style in the city.

Strange column of black and white portraits located in front of the Medical Sciences building. No idea what it represents, but maybe something artsy.

Statue of mother bear in front of the UCSF library.

The hill near my home! Look at those lines of perspective!

UCSF Medical Center at Parnassus, where we get a lot of patient contact.

On clear days, you can always see the Golden Gate Bridge. Sometimes, I will find myself gazing outside looking for the red towers, and seem to derive a curious comfort from its presence.

Irving Street!

Where all the shops and restaurants can be found as seen from a balcony at UCSF

Wednesday, January 17, 2007

In medical school, free food can be found at almost every event and a poor struggling student can always survive any famine by finding a new talk or club meeting to find sustenance. There are some unofficial sayings at UCSF: "If you can't find free food, you're just not looking hard enough" and "hey, there IS such thing as a free lunch."

Today, I managed to make it through the day with not one, not two, but FOUR free meals. 1) During our small group discussion, one of the talented students in our lovely group baked a crumb cake and brought in cinnamon buns for breakfast. I would say that this was unusual...but it really wasn't! 2) free lunch was served at a basic science journal club presentation on how chaperone protein AHA1 affects the mutant CFTR protein in cystic fibrosis; 3) free dinner was served during a volunteer organization meeting, but I had to save this dinner for another time because 4) a friend was cooking dinner and hosting a highly anticipated (by me) "Beauty and the Geek" TV viewing.

The best free food by far was (4), the pasta and asparagus dinner cooked with loving care by Paul in honor of the TV event. Sure, free food is great on every occasion, but I realized tonight that the best free food tastes better and gives the most satisfaction when it is made by someone who really cared and enjoyed by a group of friends who happen to enjoy watching reality television. This is going to sound REALLY cheesy, but until now, I never believed it when cooks say that there is a special ingredient called "care and attention," maybe even "love" in a sense.

Tuesday, January 16, 2007

Last November, I went to UCSF Student Health Services (SHS) complaining of upper abdominal pain. The doctor at the time was kind enough to squeeze me into his schedule; his name was Dr. Blumlein. Overall, I was pretty satisfied with SHS and how the doctor gave me a full work-up. Several months have passed, and I havne't thought about SHS for a long time.

However, this afternoon, the cover of a book at the UCSF bookstore caught my eye.

"Blumlein," I thought, experiencing a tingling, uncomfortable feeling between my shoulder blades that usually signals that I should have read the class syllabus last night.

I took the book off of the shelf and did what any amateur browser does: I read the back of the book, the inside flap, and then the back inside flap...and there was a picture of my doctor at SHS!

Apparently, Dr. Blumlein is a physician at SHS by day and a well-respected science fiction writer by night. He has published several novels and dozens of short stories and has been nominated several times for prizes. It amazes me that everyone at UCSF seems to lead an exciting double life or to downplay interesting accomplishments. UCSF is like a box of chocolates...you never know who or what you're going to get...

Sunday, January 14, 2007

It would be a crime for me to not tip my top hat in tribute to the fellow UCSF Synapse bloggers working tirelessly every night to entertain, delight, dazzle, and inform our loyal readers (which number in the high twenties, I'd wager, not counting ourselves). We labor like monkeys chained to typewriters. Sort of. Their websites can be found in the nifty sidebar to the right, along with the website for our mothership, UCSF Synapse.

My fellow medical student blogger, Craig Chen, is a profound thinker and writer who will captivate you with his reflections on a myriad of medical ethical dilemmas, cool science facts, and funny quotes. Jeremy, our dental student blogger, possesses a hilarious and compelling "voice" that will give you an extremely vivid impression of dental school and educate you on a variety of political and intellectual contemporary issues. Although I do not know the two pharmacy students personally, ephempharm and Lux are also very worthy reads that promise to give you the inside scoop on pharmacy school.

Each of the bloggers has a unique perspective and writing style that reveals a different facet of UCSF. I would highly recommend that you sample each blog, that way you will discover that the UCSF experience offers way more than free plastic surgery, talking mannequins, off-color Harry Potter jokes and inadvertent cadaver eating. Wait -- scratch that -- there's NO free plastic surgery.

Friday, January 12, 2007

Smoking significantly contributes to all three causes of death by various mechanisms, but (to be horribly unacademic) I remember from reading our class syllabus that a person exposed to second-hand smoke is 1/3 more likely to develop cardiovascular disease than a non-exposed person. Moreover, we learned that even a few hours of exposure to cigarette smoke led to increased platelet aggregation (or platelet aggression, as I prefer to call it) -- which I found pretty astounding. Smoking is a major health issue tackled by UCSF; please run a PubMed search on Dr. Stanton Glantz and review his amazing research in this area.

Wednesday, January 10, 2007

Medical school involves a heavy use of the imagination, and it seems to bring out the thespian in everyone. We constantly role-play, pretending to be doctors, patients, and competent medical students; we read fictitious case studies and hypothesize how we would treat the patient during problem-based learning (PBL) and small group discussions; we play with dummies and pretend to give them supplemental oxygen.

This morning we had a small group case study on a fictitious German tourist in the Himalayas suffering from high altitude sickness. After the small group session, we had a lecture given by Dr. Alan Gianotti (an emergency medicine doctor from Stanford), who has extensive experience treating patients in the Himalayas for the Himalayan Rescue Association (HRA) at 16,000 feet above sea level. Dr. Gianotti's presentation and photos were fascinating and based on real-life experiences that totally dazzled me. It was wonderful seeing the connection between hypothetical situations and true events.

This afternoon, we enjoyed our second patient s(t)imulator session with a mannequin, which was entertaining and instructive. Since other medical students are not going to experience this case until Friday, I will refrain from saying anything more. :)

Lastly, during our patient stimulator discussion, a medical student mentioned that the next bachelor for the reality TV series "The Bachelor" may be an ER physician who attended UCSF. At first, everyone seemed to find it pretty cool...UCSF deserves more exposure to the mainstream.

But then another medical student voiced a second, more troubling thought by asking, "Wait, why is he still a bachelor?"

Tuesday, January 09, 2007

Today in our cross-cultural communication lecture, the speaker had the medical students engage in some role-playing to better see a patient's perspective. Some questions that we were encouraged to ask were "What do you feel is causing your illness?" "What treatment do you think you should receive to alleviate it?" and "What worries you the most?"

Three scenarios were available for the medical students to reenact:1) Dick Cheney with angina (heart pain).2) Jennifer Lopez, who feels that she may be pregnant yet is planning to spend the next 9 months working on a movie set.3) Harry Potter with a lump on his groin.

After the students finished the doctor-patient dialogue in pairs, the speaker opened a lecture-wide discussion. The transcript was loosely thus:

Speaker: "What was your patient most worried about?"

Student #1: "Getting fat."

Speaker: "I assume that your patient was Jennifer Lopez."

Student #1: "Haha, yes."

Speaker: "But what about Harry Potter? What would he be most worried about?"

Monday, January 08, 2007

"San Francisco is a mad city inhabited by perfectly insane people whose women are of remarkable beauty." - Rudyard Kipling

The fabulous city of San Francisco has not received enough attention from me. UCSF is located in the heart of the city, and we are so privileged to live in one of the craziest, loveliest, most passionate places in the world.

If San Francisco were a woman, I would be in love with her. She has culture, but she's not snooty. She's stylish and classy, but also very natural, down-to-earth, and laid-back. She's equally at home drinking wine in Napa Valley and roughing it in the outdoors -- biking, kayaking, running, hiking, swimming. Her signature monument is a giant tomato red structure called the Golden Gate Bridge, which seems to simultaneously blend in and stand out from the stunning natural beauty that surrounds it. San Francisco (the woman) is definitely a free spirit and a champion of independent thinking and progressive social reform.

Of course, I can still objectively say that San Francisco has her faults, like all people. She's rather moody and mercurial -- unlike her flat and reliably sunny sister, Los Angeles, to the south. When I first came to San Francisco, I thought that the whole city suffered from a serious case of multiple personality disorder. Gorgeous Victorian houses are built on hills with 45 degree inclines; people are expected to parallel park on those hills; it's warm in the winter and freezing in the summer; there's thick fog everywhere!

"Nor is there any place like San Francisco itself -- much to the relief of conservative talk-show hosts...who often liken the place to Sodom and Gomorrah. Face it, the city has always been a haven for those who are a tad on the weird side by Presbyterian standards...If San Francisco had a Statue of Liberty, she would beckon, 'Send us your odd, your bizarre masses, your tired beatniks, ancient hippies, drag queens, poets, and artists, your tempermental opera singers and recalcitrant pastry chefs, your feminist firebugs and immortal quarterbacks, your transsexual tennis players yearning to breathe free.'"

- From "The Irreverent Guide to San Francisco," 4th edition.

However, now I understand that San Francisco's case of multiple personality disorder is her greatest strength and weakness. She can be anything and everything all at the same time, and you cannot help but love her for it.

"The irresistible beauty of San Francisco lies in its innate refusal to fit into any mold, beginning with the very ground upon which it is built -- steep hills and wide valleys dropping off suddenly at the edge of the continent."

Sunday, January 07, 2007

Forgive me for my terrible memory of the specific details, but a fellow medical student mentioned an amusing story recently. A non-medical friend of this student walked into the student's room, spotted "Gray's Anatomy" on the student's bookshelf, and said, "Oh, my gosh, they made the TV show into a book?"

There is a classic medical textbook called "Gray's Anatomy" (with an 'a'), which has been used for many years by students in medical school. Also, there is a hit TV show called "Grey's Anatomy" (with an 'e'), which has nothing to do with the textbook. I'm inclined to cut the lay person some slack -- it's not like I have read "Gray's Anatomy" very religiously even though it's sitting on my bookshelf too.

The diagram posted is from "Gray's Anatomy," and it depicts how spinal nerves from each vertebra correspond to specific sections of skin on the human body, which are called dermatomes. In other words, nerves from your T4 vertebra are responsible for the feeling of sensations in a thin strip on your chest along your nipple line. During Halloween, I prayed that a brave soul would paint his body in different colors and call himself "Dermatome Man." Alas, no one stepped forward.

Dermatomes is a concept that we learned in the beginning of medical school, but it was hammered home to me in an unconventional fashion when I met a teenage girl in the hospital who had been hit by a car last October. The collision had shattered her T5 vertebra and paralyzed her. When the doctor lightly scratched along her chest in the hospital, the patient could feel nothing below her nipple line in one of the most dramatic demonstrations of dermatomes that I could ever imagine. The memory has vaguely haunted me for months. My college advisor, a pediatric orthopedic surgeon, performed spinal surgery on this patient the next morning to repair some damage...but it was clear that the girl would probably be paralyzed below her chest for the rest of her life.

Several months later, I wonder how this girl is doing, how her life has changed, and what happened to her and her family. Medical school is like the TV show, "Grey's Anatomy," in that you meet actual patients with dramatic stories and heart-wrenching injuries...and everything is real and what you do matters so much.

But, a huge difference between life and TV is that the patients do not cease to exist once the credits have rolled and the music begins playing...even though the lives of these patients and your own life have intersected for the space of 30 minutes to an hour...these patients follow their own paths and you move on with your own life. And I think that it's interesting how -- unlike television -- there is very little closure regarding the lives of many of these people in the hospital, the most dramatic theatre of humanity.

Saturday, January 06, 2007

Today I attended an all-day Domestic Violence (DV) Conference held at UCSF. It's amazing to think that incredible conferences on topics ranging from cancer imaging to universal healthcare to domestic violence happen every weekend on campus. It blows my mind.

Domestic violence is a healthcare issue...here are some facts from the "Family Violence Prevention Fund" (FVPF), funded by the U.S. Department of Health and Human Services:

- "Nearly one-third (31%) of American women report being physically or sexually abused by a husband or boyfriend at some point in their lives.- In 2000, 1,247 women, more than three per day, were killed by their intimate partners.- In addition to injuries sustained during violent episodes, physical and psychological abuse are linked to a number of adverse physical health effects including arthritis, chronic neck or back pain, migraine and other frequent headaches, stammering, problems seeing, sexually transmitted infections, chronic pelvic pain, and stomach ulcers.- Children who witness domestic violence are more likely to exhibit behavioral and physical health problems including depression, anxiety, and violence towards peers. They are also more likely to attempt suicide, abuse drugs and alcohol, run away from home, engage in teenage prostitution, and commit sexual assault crimes.-Emerging research indicates that hospital-based domestic violence interventions will reduce health care costs by at least 20%.- A recent study found that 44% of victims of domestic violence talked to someone about the abuse; 37% talked to their healthcare provider. Additionally, in four different studies of survivors of abuse, 70-81% of the patients studied reported that they would like their healthcare providers to ask them privately about intimate partner violence (IPV)."

So many issues are swirling around in my head, but what strikes me the most is how the concept of domestic violence and the issues surrounding it can have similarities to so many other ideas in healthcare:- Like obesity or smoking, domestic violence is a multifactorial health problem that leads patients to suffer from physical injury, emotional trauma, and stress-related symptoms. Prevention of domestic violence at an early stage would not only save the lives of countless women, but would also save the healthcare industry a fair amount of money in the long run due to abolishment of the "revolving door" for abuse victims in the ER that currently exists in many places.- Domestic violence is like "second-hand smoke" in that it not only harms the abuse victim, but also the children and family members living in the same household. These children also suffer from physical and emotional health problems and engage in behavior that may endanger their health.- Pharmacists have a unique role because abuse often centers around issues of control, and medication and birth control becomes prime examples of how abusers can maintain power over their victims.- Doctors, nurses, and other healthcare professionals also have to be aware of "compassion fatigue" and "secondary or vicarious trauma" that can result from helping victims of domestic violence. Burn-out is a common hazard. I feel that the issues of compassion fatigue and burn-out are also very pertinent issues in oncology and hospice care that are rarely addressed by the healthcare community.

As a medical student, the most important lesson that I learned today is to ALWAYS ask about domestic violence in a private and safe environment during the clinic appointment. It seems like a simple protocol, but doctors rarely screen their patients in this manner and it makes all the difference.

To draw another parallel to a similar health issue, doctors also rarely question patients about depression and thoughts of suicide. The general stance is that doctors should always always ask...but physicians and medical students rarely do. When interviewing a double-lung transplant patient during my Foundations of Patient Care class, I asked the female patient dozens of questions during a one-hour session. She answered in short sentences and rarely volunteered any information, and I felt frustrated and helpless and maddened by the fact that she expressed ignorance on every issue, including why she had the lung transplant in the first place. Later on, during my clinical interlude in psychiatry, I stumbled upon this patient's name and discovered that she was suffering from major depressive disorder. Did I detect this during my hour-long interview? Did I even ask her whether she was feeling depressed? No...and that has made all the difference in changing my attitude and approach.

Thursday, January 04, 2007

We haven't been in anatomy lab for a month, and at first it was nice getting reacquainted with our cadaver and seeing the familar organs and muscles. Dissection is always messy and anatomic structures are never usually easy to see without a little careful cleaning and expert recognition. The memory of the smell also returned -- every cadaver smells a bit differently, which surprised me.

Anyway, I was using a scapel to slit open the trachea (the airway) with my head approximately 12 inches above the body when a spray of yellowish gunk burst out. Some of it landed in my mouth and I jumped like a jackrabbit. If anyone is curious...it tastes like it smells. Then I ran to the bathroom and washed out my mouth and maybe my GI tract.

Wednesday, January 03, 2007

While googling for studies done on new year's resolutions, I stumbled across a blog written by Dr. Greg Mankiw, an economics professor at Harvard who teaches Ec10 (http://gregmankiw.blogspot.com/). Dr. Mankiw's blog, in turn, led me to a fascinating New York Times article written today on the link between education and health.

It would seem that the most important indicator for health is the level of education attained by the patient. This correlation seems to be omnipresent and one of the most powerful indicators of lifespan, more than race or income. In fact, the more years that a child has spent in school, the more years that that child actually lives: "Three economists noted the correlation between education and health and gave some advice: If you want to improve health, you will get more return by investing in education than by investing in medical care."

The article digresses into the problems inherent in separating correlation from causation, but the idea of investing money into education for the sake of health struck me as particularly clever because it was like killing two birds with one stone (by birds...I mean education and public health, and by stone...I mean money).

Tuesday, January 02, 2007

Today begins our next Organs Block: the lungs! Class began with the anatomy of the airways and the lungs, then we had an introduction to gas exchange and a histology lecture on different parts of the respiratory system. The image above was breath-taking in lecture...the black rose shapes are pulmonary surfactant...a phospholipid-rich secretion that reduces the surface tension in alveoli. Science and art intersect in divine ways -- the results are elegant, beautiful, effortless. It really does look like an artistic museum piece to me...or maybe something my brother could draw on an Etch-a-Sketch.

Later in the day, we had our Foundations of Patient Care session in small groups of six students. We discussed our assignment completed over break concerning our family histories, our backgrounds and cultural influences that have shaped our development and views on medicine. We had to draw a family tree and write a 3-4 page essay on our personal histories. I am continually impressed with the personal stories shared by my classmates -- the struggles that they have overcome, the experiences that they have gathered, and the achievements that they are too humble to discuss. Although it's a hideous cliche -- the best part of UCSF truly is the quality of its students. How the heck did I get here?

Monday, January 01, 2007

Fear not, loyal readers, I did not keel over and die during my transcontinental flight back to Los Angeles. For the past week, I have been hiking, ice skating, going to museums, shopping, watching movies and TV, and gorging my little heart out on wonderful food at home. Also, I live near the street where the annual Rose Parade is held every January 1st...it brings back fond memories of volunteering for float decoration and nearly losing my hair in a tragic glue accident.

Very little of my vacation at home involved medicine...except when my sister sprained her ankle and I shouted, "That's your deltoid ligament!"

Then my brother hurt his arm and I yelled, "That's your biceps...wait, no...I mean your triceps. It has three heads, but I forget the names." After three months of medical school, I am surprised and appalled by how much human anatomy has been learned and how much has already been forgotten.